According to the World Health Organization (WHO), Zika virus is a Mosquito-borne disease that first appeared in Rhesus monkeys in Africa in the Zika Forest of Uganda in 1947, and later appeared in humans in Uganda and Tanzania in 1952 (WHO, 2018). Zika virus is primarily transmitted through the bite of the Aedes Mosquito which thrives primarily in tropical, subtropical, and temperate climates (WHO, 2018). The first notable outbreak of Zika virus occurred in 2007 on the Island of Yap in the South Pacific and largely due to increased global transportation, has steadily moved eastward from continent to continent, first arriving in the Americas in Brazil in 2015 followed by the United States mainland that same year where it was first diagnosed in 62 travelers who had visited affected areas (WHO, 2018). Local transmissions of Zika virus in the United States occurred in 2016 in the states of Florida and Texas (CDC, 2018). Zika virus rapidly transitioned from arrival in the United States in 2015 to become a public health emergency and a nationally reportable disease in 2016, and in 2018 remains on the CDC’s notable or reportable disease report and the WHO’s list of priority diseases (CDC, 2018; WHO, 2018). Cases of Zika virus have been reported in 44 states in the continental United States with the highest numbers in California, Florida, New York, and Texas (KFF, 2018). According to the CDC (2018), there have been “5,728 symptomatic Zika virus disease cases reported” in the United States and “37,286” in United States Territories. Currently, 86 countries worldwide have reported cases of symptomatic Zika virus (WHO, 2018). While Zika virus is generally mild or asymptomatic in nature to those who have been exposed, a pregnant woman infected with Zika virus may suffer pregnancy complications and her fetus may suffer severe brain defects such as Microcephaly or other severe birth defects (CDC, 2018).
Contributing Factors
The Aedes Mosquito that carries Zika virus may bite day or night but is considered primarily a day-biting insect and is noted for carrying other vector-borne diseases such as yellow fever, Dengue fever, and Chikungunya virus (WHO, 2018). The Aedes Mosquito is affected by environmental factors and thrives in warm climates where water can accumulate and is plentiful and hosts are abundant, so climate change and deforestation contribute to proliferation of the disease vector by providing the perfect ecosystem for the mosquito to breed followed by migration of new human hosts into once forested areas where local transmission of the disease occurs (Gulich, 2016). Poverty and health disparities also contribute to the spread of mosquito-borne viruses due to lack of adequate housing, poor access to personal protective supplies, and poor access to health care and health education (Edelman, Mandle, & Kudzma, 2014, p. 206) The most common transmission methods include mosquito bites, sexual encounters, and from pregnant mother to her fetus (CDC, 2018; WHO, 2018). The primary factors that contribute to further transmission and global spread of this disease include living or traveling in the affected areas, as well as having sexual partners who have lived or traveled in the affected areas (CDC, 2018; WHO, 2018).
Prevention Strategies
The CDC (2018) provides the following recommendations for individuals to protect themselves and others from contracting Zika virus:
- Preventing mosquito bites by removing standing water and controlling mosquitos around your home and covering exposed skin when you are outside in areas where mosquitos live.
- Plan for travel by checking the CDC’s current travel recommendations and avoid unnecessary travel if possible in areas where Zika virus is prevalent, especially if you are pregnant or plan on becoming pregnant.
- Use protection during sex if you or your partner have lived or have traveled to areas affected by Zika virus for a minimum of six months for men and two months for women and it is recommended to prevent pregnancy during this time period. Individuals interested in becoming pregnant should receive preconception counseling.
- Build a Zika prevention kit to include personal protection products if you live or plan on traveling to an area where Zika virus is prevalent.
- If you already have Zika virus, protect others by using condoms during sex and no sharing of sex toys.
The WHO recommends vigilant and ongoing vector surveillance at all international ports of entry including airports, shipyards, and ground crossings as well as the screening of all incoming travelers for signs and symptoms of Zika virus disease in order to interrupt Zika transmission.
Signs and Symptoms
The average incubation period for Zika virus is approximately two to seven days and Zika virus disease is rather insidious as up to 60% to 80% of those affected will have no signs or symptoms at all and only about 20% of those exposed will develop Zika virus disease (Gulich, 2016). The most common signs and symptoms of Zika virus disease are fever, rash, joint pain, red eyes, muscle pain, and headache which typically last a few days to a week (Gulich, 2016). Adults and children with Zika virus disease may experience neurological signs and symptoms such as neuropathy and myelitis, and the CDC (2018) is currently researching a strong connection between Zika virus disease and trigger of the neurological disorder, Guillain-Barré syndrome. Women infected with Zika virus during pregnancy may not even be aware they have passed the disease to their unborn baby until they give birth and their newborns show signs of fetal birth defects, known as “congenital Zika syndrome” (WHO, 2018).
Diagnostic Tests
During the health history assessment and update at every provider visit, all patients should be screened for recent travel and if they have confirmed travel to affected areas or report having sex with someone who has traveled to areas affected by Zika virus, testing blood, body fluids, semen or urine can be done to confirm a diagnosis of Zika virus through the presence of Zika virus antibodies (CDC, 2018; WHO, 2018). Newborns should be tested for Zika virus if it is suspected that the mother was exposed to Zika virus during her pregnancy or if they present with signs and symptoms of congenital Zika virus syndrome, as well as anyone who presents with signs and symptoms of Zika virus (CDC, 2018).
Advanced Practice Nursing Role and Management Strategies
The role of the advanced practice nurse includes staying up to date on Zika virus disease issues and following the current clinical guidelines for Zika virus disease including patient education, surveillance, screening to rule out possible West Nile virus, Dengue fever or Chikungunya virus infections and identification of appropriate treatment protocols (CDC, 2018). Pregnant women should be asked about recent travel and those who have traveled should be asked about any Zika related signs or symptoms within two weeks of traveling (CDC, 2018). Pregnant women with findings of Zika virus exposure or who have tested positive for Zika virus should be monitored via repeat ultrasounds to screen the fetus for signs of congenital Zika virus syndrome or any other abnormal findings in growth or anatomical development and referred to a maternal-fetal medicine or infectious disease specialist for further management (CDC, 2018). It is also the responsibility of the advanced practice nurse to report all incidents of Zika virus to the local public health department and any individuals who test positive for any mosquito-borne illness should be instructed to avoid being bitten by mosquitos during the first three days after exposure to reduce local transmission of the disease, and avoid direct transmission of the disease by avoiding sexual intercourse without protection or a birth control method for two months for women and six months for men (CDC, 2018). The advanced practice nurse should also advise the patient who has had recent exposure or has tested positive for Zika virus to avoid donating blood products per FDA recommendations (FDA, 2016; Lippincott Nursing Center 2018).
Medical/Pharmacological Management
There is currently no vaccine or medication to treat Zika virus disease other than management of associated signs and symptoms and prevention of secondary infections from skin rash irritation with over the counter medications (WHO, 2018). The patient should be advised to rest, drink plenty of fluids, take Tylenol as needed for fever and pain, avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) until Dengue fever is ruled out, and talk to your provider if your symptoms worsen or if you are taking any other medications for other medical conditions (CDC, 2018).
Follow-up Care
Follow-up care for patients who have been exposed to Zika virus includes assessment of the patient’s level of recovery as well as the subsequent return to a state of health and well-being, and the presence of any further complications related to Zika virus disease. Extended long-term follow-up care and support will need to be provided to patients and families affected by Zika virus disease complications (WHO, 2018). According to the CDC (2018), “The long-term prognosis for infants with congenital Zika virus infection is currently unknown”. Minimum current clinical recommendations for all children exposed to Zika virus include regular check-ups and routine preventative care including immunizations and careful monitoring of growth and development (CDC, 2018). Children with congenital Zika virus syndrome will benefit from a multi-disciplinary team approach in a medical home in order to coordinate care to address the child’s current health issues and manage any additional medical issues as needed (CDC, 2018). These children will also require additional screenings such as eye exams by an ophthalmologist, auditory brainstem response testing, and referral to specialists as needed for any presenting abnormalities (CDC, 2018). Families should be encouraged to actively participate as an integral member of their child’s care team and psychosocial support should be ongoing (CDC, 2018).
Conclusion
Although Zika virus emerged from relative obscurity to a global health threat and public health emergency in a short amount of time and was contained forthwith, the health concern is far from over. Zika virus poses a serious risk of fetal birth defects and remains an international threat for which there is no cure. In 2018, the United States reported 46 cases of imported Zika virus in travelers returning from abroad, and 98 cases of local transmission of Zika virus were reported in United States territories (CDC, 2018). To date, 93 countries worldwide reported local transmissions of Zika virus and it remains on the CDC’s list of reportable diseases and the WHO’s list of priority diseases in 2018 (CDC, 2018; WHO, 2018). Current clinical research is underway and scientists have developed a new technique for separating infected and non-infected cells to observe their behavior when infected with a virus (Buschman, 2018). Moving forward, we can all do our part to control another outbreak of Zika virus and related negative health outcomes by promoting community awareness, screening all patients for Zika virus if they have lived in or traveled to areas in which there are recent outbreaks of Zika virus, and supporting research and development in Zika virus detection, prevention, and treatment. Working in a collaborative multi-disciplinary setting, we can prevent re-emergence of this insidious disease process and increase the probability of discovering a cure.
References
- Buschman, H. (2018, September 10). Zika Virus Strips Immune Cells of their Identity. Retrieved from https://health.ucsd.edu/news/releases/Pages/2018-09-10-zika-virus-strips-immune-cells-of-their-identity.aspx
- Centers for Disease Control and Prevention (CDC). (2018, October 16). Zika Virus. Retrieved from https://www.cdc.gov/zika/
- Edelman, C., Mandle, C. L., & Kudzma, E. C. (2014). Health promotion throughout the life span (8th ed.). St. Louis, MO: Mosby.
- Gulich, A. (2016). Epidemiology, Driving Factors, Transmission and Control Options of Zika Virus: A Review. Journal of Infectious Diseases & Therapy, 04(02). doi:10.4172/2332-0877.1000278
- Henry J Kaiser Family Foundation (KFF). (2018, August 8). Cases of Zika Virus Disease in the United States. Retrieved from https://www.kff.org/other/state-indicator/cases-of-zika-virus-disease-in-the-united-states/
- Lippincott Nursing Center. (2018). ZikaVirus. Retrieved from https://www.nursingcenter.com/ resources/clinical-topics/zika-virus
- U.S. Food and Drug Administration (FDA). (2016, February 17). FDA issues recommendations to reduce the risk for Zika virus blood transmission in the United States. Retrieved from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm486359.htm
- World Health Organization (WHO). (2018, July 20). Zika virus. Retrieved from http://www.who.int/news-room/fact-sheets/detail/zika-virus
